JP2005103140A - Insertion aid for treatment of large intestine whole layer resection, and medical instrument system thereof - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an insertion aid for treatment of the large intestine whole layer resection to hardly narrower the inner lumen of the large intestine after the treatment of the large intestine whole layer resection, and a medical instrument system thereof. <P>SOLUTION: The insertion aid 3 for treatment of the large intestine whole layer resection raises an organic tissue to be treated to an operation space 7 through a treatment side hole 6, and resects a region of the organic tissue above the ligated region of the organic tissue by a resection snare unit 11 after ligating the root of the raised organic tissue to be ligated by a ligator 16. The shape of the treatment side hole 6 of a sheath part 5 of the treatment insertion aid 3 is set so that the length in the direction orthogonally crossing the axial direction of the sheath part 5 is longer than the length in the axial direction of the sheath part 5. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to an insertion for treatment of full-thickness colorectal resection in which an endoscope and a treatment tool are inserted into an insertion assisting tool for full-thickness resection of a large intestine introduced into a body cavity to perform treatment such as full-thickness resection of the large intestine It is related with an auxiliary tool and its medical device system.

  2. Description of the Related Art Conventionally, a system has been developed in which an endoscope is inserted into the large intestine from the anus, and the entire large intestine including the mucous membrane layer and muscle layer is collectively removed. For example, in Patent Document 1, a tubular treatment insertion aid in the form of an overtube is attached in advance to an insertion portion of a first endoscope, and the treatment insertion aid is inserted into the large intestine by the first endoscope. Inserted into. Thereafter, the first endoscope is withdrawn from the treatment insertion aid, whereby only the treatment insertion aid is placed in the large intestine. In this state, the second endoscope, the ligation treatment tool, and the resection treatment tool are inserted into the large intestine through the inside of the treatment insertion aid.

  Then, in a state where the biological tissue to be treated is grasped by the grasping treatment tool such as grasping forceps inserted into the large intestine through the endoscope channel of the second endoscope, the biological tissue to be treated is pulled up. The biological tissue to be treated is lifted by moving the grasping treatment tool. Then, after ligating the base portion of the lifted living tissue with a ligation treatment tool, the upper portion of the ligated portion of the ligated biological tissue is excised with a resection treatment tool. As a result, the entire large intestine is excised. Here, in the device of the conventional configuration, the entire body of the large intestine can be obtained by penetrating, for example, a puncture needle from the side into the pulled up living tissue and placing a ligation tool such as T-BAR or ligating with a stapler. Is sutured.

Further, when the large intestine tissue is grasped / lifted by the grasping treatment tool inserted through the endoscope, a frame-shaped tissue pressing member is disposed around the large intestine tissue to be lifted. And, in the state where the large intestine tissue is grasped by the grasping treatment tool in the opening of the frame of the tissue pressing member, by suspending the large intestine tissue, the ligation process of the large intestine tissue by the ligation treatment tool in the next step, The excision process with the excision instrument is made easier.
JP 2000-37347 A

  In the above-conventional apparatus, when the lifting amount when grasping / raising the large intestine tissue with a grasping treatment tool is large, a part of the large intestine corresponding to the suture site is extremely locally in the radial direction of the large intestine. The colon tissue may be squeezed and sutured. This portion may narrow the colon cavity after suturing.

  The present invention has been made paying attention to the above circumstances, and its purpose is to provide an insertion assisting tool for full-colorectal resection and a medical instrument system thereof that rarely narrow the colon cavity after full-colorectal resection. It is to provide.

  The present invention according to claim 1 is a treatment side hole for inserting a living tissue to be treated into one side portion of the distal end portion outer peripheral surface of the large intestine insertion portion to be inserted into the large intestine, and the other side portion of the distal end portion outer peripheral surface. Working space portions for full-colorectal resection treatment are respectively formed on the living body tissue to be treated through the side holes for treatment to the working space portion, and the root portion of the living tissue to be ligated is lifted In the insertion assisting tool for full-thickness colorectal resection in which the upper part of the ligated portion of the living tissue is excised with a surgical instrument for excision after the ligating means is ligated, The insertion for treatment of full-thickness colorectal resection, wherein the shape of the side hole is set so that the length in the direction orthogonal to the axial direction is longer than the length in the axial direction of the insertion portion in the large intestine It is an auxiliary tool.

  According to the first aspect of the present invention, during the entire colorectal resection treatment, the living tissue to be treated is pulled up to the working space through the treatment side hole, and the root portion of the living tissue to be treated is ligated. Ligation by means. At this time, the shape of the treatment side hole of the insertion part in the large intestine is set so that the length in the direction orthogonal to the axial direction is longer than the length in the axial direction of the insertion part in the large intestine. When the living tissue is pulled up to the working space through the treatment side hole, the cross-sectional shape of the treatment target biological tissue to be pulled up is close to the shape of the treatment side hole. Therefore, the excision hole shape of the living tissue to be treated excised by the excision treatment tool can be increased in length in the direction perpendicular to the axial direction compared to the axial length in the large intestine. When ligating the peripheral portion of the hole, the peripheral portions of the portion having a short length in the axial direction of the excision hole can be joined. This prevents the colon cavity from being narrowed after suturing.

  According to the second aspect of the present invention, in the large intestine insertion portion, the length of the treatment side hole is longer in the direction perpendicular to the axial direction than the axial length of the large intestine insertion portion. 2. The insertion assisting device for treatment of full-thickness resection of the large intestine according to claim 1, wherein the insertion aid is a rectangular shape set as described above.

  In the invention of claim 2, when the living tissue to be treated is pulled up into the working space through the treatment side hole, the cross-sectional shape of the treatment target biological tissue is the shape of the treatment side hole. It becomes a close rectangular shape. Therefore, the shape of the excision hole of the biological tissue to be treated to be excised by the excision treatment tool can be made rectangular with the length in the direction orthogonal to the axial direction being longer than the axial length in the large intestine. When the peripheral part of the excision hole of the large intestine is ligated, the peripheral part of the part with a short length in the axial direction of the excision hole can be joined. This prevents the colon cavity from being narrowed after suturing.

  According to a third aspect of the present invention, in the large intestine insertion portion, the length of the treatment side hole is longer in the direction perpendicular to the axial direction than the axial length of the large intestine insertion portion. The insertion assisting device for treatment of full-thickness resection of the large intestine according to claim 1, wherein the insertion assisting device is an oval shape set as described above.

  In the invention of claim 3, when the living tissue to be treated is pulled up into the working space through the treatment side hole, the cross-sectional shape of the treatment target biological tissue is the shape of the treatment side hole. It becomes a close elliptical shape. Therefore, the shape of the excision hole of the biological tissue to be treated to be excised by the excision treatment tool can be made into an elliptical shape in which the length in the direction orthogonal to the axial direction is longer than the axial length in the large intestine. When the peripheral part of the excision hole of the large intestine is ligated, the peripheral part of the part with a short length in the axial direction of the excision hole can be joined. This prevents the colon cavity from being narrowed after suturing.

  According to a fourth aspect of the present invention, in the insertion portion in the large intestine, a narrow narrow portion is formed in the middle portion in the axial direction in the treatment side hole, and the living tissue is ligated by the narrow portion when the living tissue is ligated. 4. The insertion assisting device for treatment of full thickness resection of the large intestine according to any one of claims 1 to 3, wherein a bent portion can be formed when the ligated portion is folded.

  In the fourth aspect of the present invention, when the living tissue to be treated is pulled up to the working space through the treatment side hole, the living tissue is formed by the narrow portion of the midway portion in the axial direction of the treatment side hole. A bent portion is formed when the ligature portion is folded.

  According to a fifth aspect of the present invention, the intra-colon insertion portion is formed by forming a distal tip constituent portion ahead of the treatment side hole and a rear portion of the treatment side hole by a soft soft member, and The insertion assisting device for full colorectal resection according to claim 1, wherein a frame member harder than the soft member is formed between the component part and a rear part of the treatment side hole. It is.

  In the invention of claim 5, the front-end constituent part of the insertion part in the large intestine is provided in front of the treatment side hole, and the part that is easily elastically deformed by the soft soft member in the rear part of the treatment side hole is provided. Thus, the length of the insertion part in the large intestine is made short only by the length part of the frame member. As a result, the insertion portion into the large intestine can be improved by elastically deforming the tip constituting part of the treatment side hole and the rear part of the treatment side hole into an arbitrary shape when inserted into the large intestine. It is.

  According to the sixth aspect of the present invention, the insertion portion in the large intestine is supported such that the distal end configuration portion can be expanded and contracted with respect to a rear portion with respect to the treatment side hole, and the opening width in the axial direction of the treatment side hole is 6. The insertion assisting device for treatment of full thickness resection of the large intestine according to claim 5, further comprising a length adjusting unit capable of adjusting the length.

  And in invention of this Claim 6, the whole length is shortened by pushing the front-end | tip component part of the large intestine insertion part in the state which approaches a back part rather than the treatment side hole, and insertion property to a body is carried out. To increase. Furthermore, the length of the appropriate opening width in the axial direction of the treatment side hole is ensured by projecting the distal end constituent portion of the intra-colon insertion portion forward from the rear portion of the treatment side hole. As a result, the insertion into the body is improved, and at the same time, the entire colorectal resection operation can be reliably performed.

  The present invention according to claim 7 is a treatment side hole for inserting a living tissue to be treated into one side portion of the distal end portion outer peripheral surface of the large intestine insertion portion to be inserted into the large intestine, and the other side portion of the distal end portion outer peripheral surface. Working space portions for full-colorectal resection treatment are respectively formed on the living body tissue to be treated through the side holes for treatment to the working space portion, and the root portion of the living tissue to be ligated is lifted In the insertion assisting tool for full-thickness colorectal resection in which the upper part of the ligated portion of the living tissue is excised with a surgical instrument for excision after the ligating means is ligated, The shape of the side hole is set so that the length in the axial direction of the insertion part in the large intestine is longer than the length in the direction orthogonal to the axial direction. It is an insertion aid.

  In the seventh aspect of the present invention, the living tissue to be treated is pulled up to the working space through the treatment side hole at the time of full-thickness resection of the large intestine, and the root portion of the treated living tissue is ligated. Ligation by means. At this time, the shape of the treatment side hole of the large intestine insertion part is set so that the length in the axial direction of the large intestine insertion part is longer than the length in the direction orthogonal to the axial direction. It can be sutured with a puncture needle. As a result, the number of puncture needles used is reduced to reduce the overall outer diameter of the large intestine insertion portion.

  The present invention according to claim 8 is a ligation channel in which at least an endoscope insertion channel and a ligation treatment tool for inserting a ligation tool for ligation of biological tissue are inserted into an insertion portion in the large intestine to be inserted into the large intestine. And a side hole for treatment into which a biological tissue to be treated is inserted into one side of the outer peripheral surface of the distal end portion of the insertion portion, and an outer periphery of the distal end portion. A treatment insertion assisting tool in which a working space portion for a full-thickness colorectal resection treatment is formed on the other side of the surface, the ligation treatment tool inserted into the ligation channel, and the endoscope insertion channel An endoscope to be inserted up to the working space, and a grasping portion provided with a grasping portion for grasping a living tissue at a distal end portion of the insertion portion to be inserted into the working space through the channel of the endoscope A treatment tool and the excision channel A treatment tool for excision inserted into the handle, and in a state where the biological tissue to be treated is grasped by the grasping portion of the grasping treatment tool, the biological tissue to be treated is obtained by the bending operation of the endoscope. After performing the lifting operation through the treatment side hole, the base portion of the biological tissue to be treated that has been pulled up is ligated by the ligation treatment tool, and the upper portion of the ligated portion of the ligated biological tissue is used for the excision. A medical instrument system for excision with a treatment instrument, wherein the treatment insertion assisting tool has a shape in which the shape of the treatment side hole is perpendicular to the axial direction compared to the axial length of the treatment insertion assisting tool. The medical device system is characterized in that the length is set to be long.

  In the invention of claim 8, the living tissue is grasped by the grasping portion of the grasping treatment tool inserted into the working space through the channel of the endoscope at the time of the entire colorectal resection treatment. In this state, the living tissue to be treated is pulled up to the working space through the treatment side hole by the bending operation of the endoscope. Subsequently, the root portion of the biological tissue to be treated that has been pulled up is ligated with a treatment tool for ligation. At this time, the shape of the treatment side hole of the insertion part in the large intestine is set so that the length in the direction orthogonal to the axial direction is longer than the length in the axial direction of the insertion part in the large intestine. When the living tissue is pulled up to the working space through the treatment side hole, the cross-sectional shape of the treatment target biological tissue to be pulled up is close to the shape of the treatment side hole. Therefore, the length of the cross-sectional shape of the biological tissue to be treated to be excised by the excision treatment tool is increased by making the length in the direction orthogonal to the axial direction longer than the axial length in the large intestine. The cross-sectional shape of the excised portion of the living tissue to be excised can be shortened in the axial direction in the large intestine. This prevents the colon cavity from being narrowed after suturing.

  In the ninth aspect of the present invention, the treatment insertion assisting tool has an endoscope insertion portion for inserting a guide endoscope that is inserted into the body in advance on the distal end side of the treatment side hole. The medical instrument system according to claim 8.

  In the ninth aspect of the present invention, the insertion of the treatment insertion assisting tool inserted into the body by inserting the guide endoscope through the endoscope insertion portion closer to the distal end than the treatment side hole is performed. It is intended to enhance the nature.

  In the tenth aspect of the present invention, the treatment insertion assisting tool is protruded forward from the resection channel at a position corresponding to the resection channel at an end portion on the distal end side of the treatment side hole. The medical instrument system according to claim 8, further comprising a pressing member that suppresses lifting of the distal end portion of the treatment tool for excision.

  In the invention of claim 10, when setting the excision treatment tool in the treatment insertion auxiliary tool, the excision treatment tool is projected forward from the excision channel. At this time, the setting of the treatment tool for excision is performed by suppressing the lifting of the distal end of the treatment tool for excision by the pressing member at a position corresponding to the channel for excision at the end on the distal end side from the treatment side hole. It is designed to be easily performed.

  According to the eleventh aspect of the present invention, the treatment tool for excision is inserted in a snare wire in which a excision loop portion whose distal end side can be expanded in a loop shape is formed, and a proximal end side of the snare wire is inserted in a press-fit state. The medical instrument system according to claim 10, wherein the medical device system is formed by a cutting snare having a ring-shaped throttle member, and the pressing member has a stopper for positioning a tip position of the cutting snare. .

  In the eleventh aspect of the present invention, when the excision snare is set in the treatment insertion aid, the excision snare is projected forward from the excision channel. At this time, the lifting of the distal end portion of the excision snare is suppressed by a pressing member at a position corresponding to the excision channel at the end portion on the distal end side with respect to the treatment side hole. In addition, with the tip of the excision snare abutting against the stopper of the pressing member and the tip of the excision snare positioned, the excision snare is further pushed out, so that the loop part of the excision snare is securely It is made to expand in a loop shape.

  According to the present invention of claim 12, the treatment insertion assisting tool is provided between the left and right ligation channels disposed on the inner side of both side portions of the treatment side hole in the vicinity of the treatment side hole of the insertion portion. The medical instrument system according to claim 8, further comprising a flat meat drop portion in which a wall portion of a lower portion of the connecting plane is cut out.

  In the invention of claim 12, the treatment insertion assisting tool is obtained by reducing the outer diameter of the entire insertion part of the treatment insertion assisting tool by the planar meat drop portion of the insertion part of the treatment insertion assisting tool. This is designed to improve the insertability.

  ADVANTAGE OF THE INVENTION According to this invention, the insertion auxiliary tool for treatment of the full-thickness colorectal resection and its medical device system which rarely narrow the colon cavity after the full-thickness colorectal resection treatment can be provided.

  The first embodiment of the present invention will be described below with reference to FIGS. 1 to 11A and 11B. FIG. 1 shows a schematic configuration of the entire medical instrument system 1 for excision of the entire large intestine of the present embodiment. The medical instrument system 1 according to the present embodiment includes an endoscope 2 and a treatment insertion aid 3.

  The endoscope 2 includes an elongated insertion portion 2a that is inserted into the body, and a proximal-side operation portion 2b that is connected to the proximal end of the insertion portion 2a. The insertion portion 2a has an elongated flexible tube portion 2c having flexibility, a hard distal end portion 2d disposed at the foremost position, and a bending portion 2e capable of bending deformation. Inside the insertion portion 2a, a plurality of operation wires, a control signal cable, a light guide cable, a water / water intake / air intake / intake tube, various probe channels, and the like are provided.

  The endoscope 2 according to the present embodiment is a side-view endoscope in which the visual field direction of the observation optical system at the distal end portion 2d is oriented in the direction orthogonal to or substantially rearward from the axial direction of the insertion portion 2a. On the side surface of the distal end portion 2c, there are provided an illumination window, an observation window, an air / water channel opening, a forceps channel opening that also serves as a suction port, and the like. The exit end of the light guide cable is disposed opposite to the inner surface of the illumination window. On the inner surface of the observation window, an objective lens of the observation optical system, an electronic image pickup device (CCD) that images a subject observed by the objective lens, and the like are disposed. The illumination light is projected from the light emitting end of the light guide cable through the illumination window, and the subject illuminated with the projected illumination light is imaged by the electronic image sensor.

  The distal end portion 2c of the endoscope 2 is provided with a forceps raising base (not shown) in the forceps channel opening. This forceps raising base is operated by a forceps raising knob (not shown) provided in the operation section 2b. And the protrusion direction of the front-end | tip holding part 4a of the grasping forceps 4 mentioned later inserted in the forceps channel is deflected by the raising operation | movement of this forceps raising stand.

  In addition, a base end portion of the universal cord 2f is connected to the operation portion 2b. The other end of the universal cord 2f is connected to the light source device via a connector (not shown). The illumination light from the light source device is supplied to the light guide cable in the universal cord 2f. An electrical cable is further connected to the connector. This electric cable is connected to a camera control unit (CCU) via an electric connector. Then, after the endoscopic image of the subject imaged by the observation optical system is converted into an electric signal by the electronic image sensor, this electric signal is transmitted to the camera control unit via the control signal cable, and is displayed on a display monitor (not shown). It is displayed.

  Further, the operation section 2b is provided with an operation knob 2g for bending operation, a forceps channel insertion port 2h, a forceps raising knob (not shown), and the like. Then, the operation wire in the insertion portion 2a is pulled by the operation of the operation knob 2g, and the bending portion 2e is bent, for example, up, down, left, and right to change the direction of the distal end portion 2c.

  The grasping forceps 4 is inserted into the forceps channel insertion opening 2h, and the tip gripping portion 4a provided at the tip of the grasping forceps 4 is projected from the distal end portion 2c of the insertion portion 2a into the body cavity. It has become. At this time, by operating a forceps raising knob (not shown) of the operation portion 2b, the forceps raising base of the forceps channel opening of the tip portion 2c is raised, and the protruding direction of the tip gripping portion 4a inserted through the forceps channel is deflected. It is supposed to let you.

  As shown in FIG. 6, the treatment insertion aid 3 includes a sheath portion (insertion portion in the large intestine) 5 to be inserted into the large intestine H <b> 1 and a grip portion 5 a connected to the proximal end portion of the sheath portion 5. Is provided. Furthermore, an endoscope insertion channel 8 (described later) into which the insertion portion 2a of the endoscope 2 is inserted is formed in the sheath portion 5 and the grip portion 5a of the treatment insertion assisting tool 3.

  The sheath portion 5 has flexibility to freely follow the bending of the insertion portion 2a of the endoscope 2, for example, polyurethane, vinyl chloride, polyurethane elastomer, polystyrene elastomer, polyolefin elastomer, polyester elastomer, polyamide It is made of a relatively flexible resin material such as a base elastomer, fluororesin (porous), and other various thermoplastic elastomers, and has the same length as the large intestine, preferably 600 mm or more and about 1700 mm.

  As shown in FIGS. 2A and 2B, the distal end portion of the sheath portion 5 has a treatment side hole 6 for inserting a living tissue to be treated into one side portion of the outer peripheral surface, and the other side of the outer peripheral surface of the distal end portion. Work space portions 7 for the entire colorectal resection treatment are formed in the respective portions. The work space 7 for the full-colorectal resection treatment is formed by a slit in which the upper half of the distal end portion of the sheath portion 5 is cut out in FIG. In the working space portion 7 of the slit, the distal end portion 2c of the insertion portion 2a of the endoscope 2 inserted from the grip portion 5a of the treatment insertion assisting tool 3 protrudes.

  The treatment side hole 6 is formed by a substantially rectangular opening that opens in the lower half of the distal end portion of the sheath portion 5 in FIG. Here, the opening shape of the treatment side hole 6 is formed in a horizontally long rectangular shape that is long in a direction orthogonal to the axial direction of the sheath portion 5 as shown in FIG. The rectangular shape of the horizontally long treatment side hole 6 is set so that the length L2 in the direction orthogonal to the axial direction is longer than the length L1 in the axial direction.

  Further, as shown in FIG. 3, the sheath portion 5 of the treatment insertion aid 3 includes at least one endoscope insertion channel 8, a plurality of, in this embodiment, four ligation channels 9, and one excision. It is formed by a multi-lumen tube having a channel 10. Here, the endoscope insertion channel 8 is disposed at a position corresponding to the working space portion 7 of the sheath portion 5. Then, four ligation channels 9 and one excision channel 10 are arranged at positions corresponding to the ligation and excision parts arranged below the working space portion 7.

  Further, the excision channel 10 is arranged at a position facing the substantially central portion of the ligation excision in FIG. Two ligation channels 9 are juxtaposed on both sides of this excision channel 10.

  A resection snare unit (resection treatment tool) 11 is inserted into the resection channel 10. The excision snare unit 11 includes an excision snare 12 and an excise snare introduction tube 13 through which the excise snare 12 is inserted. In the excision snare 12, an excision loop portion 15 having a spreading behavior in a loop shape is formed at the distal end portion of the elongated operation wire 14.

  The four ligation channels 9 are inserted with ligation treatment tools 17 for ligating a ligation tool 16 for ligation of living tissue (see FIG. 5) to the biological tissue to be treated. As shown in FIG. 5, the ligation tool 16 of the present embodiment has two substantially cylindrical T bars 16a and 16b, and a T bar sheath 16c that connects substantially central portions of the T bars 16a and 16b. The overall shape is formed in an H shape. The T-bar sheath 16c is thinner than the T-bars 16a and 16b, and has a length corresponding to approximately four layers of the large intestine to be ligated. The lengths of the T bars 16a and 16b are about the entire layer, and the length is about 5 to 15 mm, preferably about 10 mm.

  The ligature 16 is relatively flexible such as polyurethane, vinyl chloride, polyurethane elastomer, polystyrene elastomer, polyolefin elastomer, polyester elastomer, polyamide elastomer, fluororesin (porous), and other various thermoplastic elastomers. Made of resin material.

  Further, the ligation treatment instrument 17 is provided with four puncture needles 18 respectively inserted into the four ligation channels 9. As shown in FIG. 6, each puncture needle 18 is provided with a hollow needle member 19. The needle member 19 is formed of a metal pipe made of a material such as stainless steel or nitinol, and has an inner diameter of about 0.5 to 1.5 mm and an outer diameter of about 0.7 to 2.0 mm. The needle member 19 may be formed of a resin tube such as a fluororesin, polyethylene, polyamide, polyimide, polyurethane, various thermoplastic elastomers, or a metal coil. In addition, in order to make it difficult to buckle, a resin tube may be put on the outside of the metal coil, or a resin tube containing a metal mesh may be used.

  A sharp needle tip portion 19a having an inclined surface that is notched in a direction obliquely intersecting the axial direction is formed at the distal end portion of the needle member 19. Thereby, the needle tip portion 19a of the needle member 19 can puncture the tissue in the body cavity.

  Furthermore, a slit 19 b is provided along the axial direction on the outer peripheral surface of the distal end portion of the needle member 19. As shown in FIG. 4, a slit 9 a is formed at the tip of each ligation channel 9 at a position corresponding to the slit 19 b of the puncture needle 18.

  A substantially rod-shaped protruding member 20 is slidably inserted into the needle member 19 of the puncture needle 18. A distal end portion of a pusher wire 21 formed of a metal wire material such as a stainless steel member is connected to the base end of the protruding member 20.

  In addition, the grasping portion 5a of the treatment insertion assisting tool 3 is provided with a ligation / removal operation unit 22 for independently operating the resection snare unit 11 and the ligation treatment tool 17. The ligation and excision operation unit 22 includes an excision operation unit 23 that operates the excision snare unit 11 and a ligation operation unit 24 that operates the treatment tool 17 for ligation.

  The excision operation portion 23 includes a stopper 23a to which the proximal end portion of the excision snare introduction tube 13 is connected, and a handle 23b to which the proximal end portion of the operation wire 14 of the excision snare 12 is connected. Here, when the stopper 23a and the handle 23b are moved to the forward pushing position, the excision snare introduction tube 13 and the excision snare 12 are set to the set position for the excision operation as shown in FIG. The At this time, the distal end portion of the excision snare introduction tube 13 is moved to a position protruding from the excision channel 10, and the loop portion 15 of the excision snare 12 protrudes from the excision snare introduction tube 13 and has a treatment side hole. 6 is surrounded.

  In this state, by pulling out the handle 23b, the loop portion 15 of the excision snare 12 is drawn into the excision snare introduction tube 13 so as to hold the target portion.

  Further, the ligation operation unit 24 includes a needle introduction tube 25 into which the needle member 19 of the puncture needle 18 is inserted, a needle slider 26 to which the proximal end of the needle introduction tube 25 is connected and fixed, a needle introduction tube 25 and a needle. A puncture needle push-out stopper 27 to which the proximal end of the needle member 19 inserted in the slider 26 is connected and fixed, and a pusher wire stopper 28 to which the proximal end portion of the pusher wire 21 is connected and fixed are provided.

  That is, the puncture needle 18 is pushed out by pushing the puncture needle push-out stopper 27 against the needle slider 26, and the pusher wire 21 is pushed out by the pusher wire stopper 28 so that the protruding member 20 is pushed forward from the puncture needle 18. It has become.

  When the puncture needle push-out stopper 27 is completely pulled out from the needle slider 26, the tip of the puncture needle 18 is set so as to be located behind the treatment side hole 6 as shown in FIG. Further, when the puncture needle push-out stopper 27 is completely pushed into the needle slider 26, the distal end of the puncture needle 18 reaches a position beyond the distal end side of the treatment side hole 6 as shown in FIG. Is set. At this time, if the length of the treatment side hole 6 protruding from the distal end side is 10 mm or more, the large intestine drawn into the treatment side hole 6 can be easily penetrated, preferably about 20 mm.

  Further, the ligation tool 16 is operated by pulling out the pusher wire stopper 28 of the ligation operation unit 24 and pulling the pusher wire 21 and the protruding member 20 toward the proximal side of the puncture needle 18 as shown in FIG. 18 slits 19b. FIG. 4 shows a state in which the ligation tool 16 is set on the treatment insertion aid 3. Here, one ligation tool 16 is set in a state where two ligation channels 9 are used. In this embodiment, two ligation tools 16 are set in the four ligation channels 9.

  The set state of the two ligatures 16 is exactly the same. Therefore, here, the set state of one ligation tool 16 will be described. A puncture needle 18 is inserted into each ligation channel 9. Then, the T bars 16 a and 16 b of the ligation tool 16 are set in a state of being inserted into the slits 19 b of the puncture needles 18 of the two ligation channels 9. At this time, the T-bar sheath 16c of the ligation tool 16 is set in a state where the slit 19b of each puncture needle 18 and the slit 9a of the ligation channel 9 are inserted from the distal end side of the needle member 62a.

  Here, the slit 19b of each puncture needle 18 has such a width that the T-bars 16a and 16b and the protruding member 20 cannot be inserted, and the length of the slit 19b is slit at the connecting portion between the T-bars 16a and 16b and the T-bar sheath 16c. When positioned on the proximal end side of 19b, the lengths of the T bars 16a and 16b are set so as not to be exposed from the distal end of the puncture needle 18. Then, when the puncture needle 18 is protruded from each ligation channel 9 and the distal end of the puncture needle 18 is positioned at the ligation position in front of the treatment side hole 6, the proximal end side of the slit 19b is the punctured colon tissue. It is set so as to be arranged at substantially the same position as the rear end position.

  Next, the operation of the above configuration will be described. When the medical instrument system 1 of the present embodiment is used, first, after the treatment insertion aid 3 is extrapolated to the direct-viewing type colonoscope 29 shown in FIG. 7, the colonoscope 29 is first placed in the colon H1. Insert to the treatment target site. Subsequently, the treatment insertion aid 3 is inserted to the treatment target site along the large intestine endoscope 29. Thereafter, the large intestine endoscope 29 is removed from the treatment insertion aid 3.

  After removal of the large intestine endoscope 29, the endoscope 2 is inserted into the treatment insertion aid 3. The distal end portion 2d of the insertion portion 2a of the endoscope 2 is inserted up to the affected portion of the large intestine H1 for treatment. In this state, with the endoscope 2 inserted into the treatment insertion aid 3, the treatment side hole 6 of the treatment insertion aid 3 is aligned with the treatment target site under the field of view of the endoscope 2. At this time, the insertion position of the sheath portion 5 of the treatment insertion assisting tool 3 is adjusted so that the center of the treatment target site coincides with the center of the treatment side hole 6. In this state, the stopper 23a and the handle 23b of the excision operation unit 23 are moved to the forward pushing position, and the excision snare introduction tube 13 and the excision snare 12 are set for excision operation as shown in FIG. Set to position. At this time, the loop portion 15 of the excision snare 12 is held in a state of surrounding the treatment side hole 6.

  Thereafter, the grasping forceps 4 is inserted into the forceps channel insertion opening 2 h of the endoscope 2. The tip gripping portion 4a of the gripping forceps 4 inserted through the forceps channel of the endoscope 2 is projected outside from the forceps channel opening of the tip portion 2c of the endoscope 2 as shown in FIG. In this state, the tip gripping portion 4 a of the gripping forceps 4 is moved toward the treatment side hole 6.

  Subsequently, the treatment target site of the large intestine H1 is gripped by the tip gripping portion 4a of the gripping forceps 4. In this state, the bending portion 2e of the endoscope 2 is bent, so that the distal end portion 2c of the insertion portion 2a is raised as shown in FIG. The working space 7 is pulled up through.

  Thereafter, the puncture needle 18 is pushed out by pushing the puncture needle push-out stopper 27 against the needle slider 26 of the ligation operation unit 24. At this time, as shown in FIG. 9, the puncture needle 18 is punctured at the root portion of the tissue to be treated of the large intestine H1 that has been pulled up. In this state, the pusher wire 21 is then pushed in by the pusher wire stopper 28 of the ligation operation unit 24. At this time, the protruding member 20 is pushed out via the pusher wire 21, and the T bars 16 a and 16 b of the ligature 16 are pushed out by the protruding member 20. By the pushing operation of the projecting member 20, the T bars 16a and 16b penetrate the root portion of the tissue to be treated of the pulled large intestine H1, and penetrate to the front of the tissue to be treated of the pulled large intestine H1 (all layers of the large intestine H1). Pushed into position.

  In this state, the puncture needle push-out stopper 27 is pulled out with respect to the needle slider 26, and the puncture needle 18 is pulled out to the hand side. By this operation, the puncture needle 18 is pulled out from the treatment target tissue of the large intestine H1. At this time, since the T bars 16a and 16b of the ligation tool 16 are left at a position that penetrates to the front of the tissue to be treated of the pulled large intestine H1, the root portions of the tissue to be treated of the pulled large intestine H1 are T bars 16a and 16b. And ligated in a form sandwiched between T-bar sheaths 16c (see FIG. 10).

  Thereafter, by pulling out the handle 23 b of the excision operation portion 23, the loop portion 15 of the excision snare 12 is drawn into the excision snare introduction tube 13. At this time, as shown in FIG. 10, the upper part of the large intestine H1 ligated by the ligation tool 16 is cut off by the loop portion 15 of the excision snare 12 from the ligated portion of the tissue to be treated. As a result, the entire layer of the large intestine H1 is excised.

  Therefore, the above configuration has the following effects. That is, in the treatment insertion assisting tool 3 of the medical instrument system 1 of the present embodiment, the shape of the treatment side hole 6 of the sheath portion 5 is perpendicular to the axial direction as compared to the axial length L1 of the sheath portion 5. The length L2 is set to be longer. Therefore, when the living tissue to be treated is grasped by the distal end grasping portion 4a of the grasping forceps 4 during the entire layer resection of the large intestine H1, it is pulled up when it is pulled up to the working space portion 7 through the treatment side hole 6. The cross-sectional shape of the biological tissue to be treated can be shaped close to the shape of the treatment side hole 6. As a result, the base portion of the biological tissue to be treated is ligated with the ligature tool 16 and then excised by the loop portion 15 of the excision snare 12 so that the large intestine H1 is obtained as shown in FIG. The length M1 in the axial direction can be made shorter than the length M2 in the direction perpendicular to the axial direction in the large intestine H1 in the shape of the excised hole H2 formed. Thereby, when the peripheral part of the excision hole H2 of the large intestine H1 is ligated with the two ligation instruments 16, the two ligation instruments 16 are arranged in a direction orthogonal to the axial direction in the large intestine H1. The peripheral portions of the portion having the short length M1 in the axial direction can be joined by the two ligature tools 16. Therefore, in the portion ligated with the ligation tool 16, compression in the direction orthogonal to the axial direction in the large intestine H1 can be almost eliminated, and axial compression in the large intestine H1 can also be reduced. As a result, since a part of the large intestine H1 is not locally squeezed and sutured in the radial direction of the large intestine H1 as in the prior art after the treatment of full thickness resection of the large intestine, the lumen of the large intestine H1 It is possible to prevent narrowing.

  The present embodiment shows a configuration in which the treatment side hole 6 is formed by a rectangular opening having a length L2 in the direction orthogonal to the axial direction longer than the axial length L1 of the sheath portion 5. However, the shape of the treatment side hole 6 is such that the length (short axis length) L2 in the direction orthogonal to the axial direction is longer than the axial length (long axis length) L1 of the sheath portion 5. It may be oval or oval.

  FIGS. 12A to 12C show a second embodiment of the present invention. In the present embodiment, the configuration of the treatment insertion assisting tool 3 in the medical instrument system 1 for full-thickness resection of the large intestine according to the first embodiment (see FIGS. 1 to 11A and 11B) is as follows. It has been changed. The rest of the structure is the same as that of the medical device system 1 for full colorectal resection of the first embodiment, and the medical device system 1 for full thickness resection of the large colorectum of the first embodiment. The same parts are denoted by the same reference numerals, and the description thereof is omitted here.

  That is, in this embodiment, as shown in FIG. 12 (A), the shape of the treatment side hole 6 formed at the distal end portion of the sheath portion 5 is a vertically long rectangular opening that is long in the axial direction of the sheath portion 5. The part 31 is changed. The rectangular shape of the vertically long opening 31 is set so that the length L4 in the direction orthogonal to the axial direction is shorter than the length L3 in the axial direction of the sheath 5.

  Furthermore, in the present embodiment, the sheath portion 5 of the treatment insertion aid 3 is provided with one excision channel 10 and two ligation channels 9. The excision channel 10 is disposed at a position facing the substantially central portion of the ligation excision in FIG. Two ligation channels 9 are arranged on both sides of the ablation channel 10, respectively.

  Next, the operation of the present embodiment having the above configuration will be described. When using the treatment insertion assisting tool 3 of the present embodiment, the treatment insertion assisting tool 3 is inserted to the treatment target site of the large intestine H1 mainly by the same procedure as in the first embodiment. Thereafter, the endoscope 2 is inserted into the treatment insertion aid 3. The distal end portion 2d of the insertion portion 2a of the endoscope 2 is inserted up to the affected portion of the large intestine H1 for treatment. In this state, with the endoscope 2 inserted into the treatment insertion aid 3, the treatment side hole 6 of the treatment insertion aid 3 is aligned with the treatment target site under the field of view of the endoscope 2. In this state, the stopper 23a and the handle 23b of the excision operation unit 23 are moved to the forward pushing position, and the excision snare introduction tube 13 and the excision snare 12 are set for excision operation as shown in FIG. Set to position. At this time, the loop portion 15 of the excision snare 12 is held in a state of surrounding the vertically long opening 31 of the treatment side hole 6.

  Thereafter, as in the first embodiment, the treatment target region of the large intestine H1 was grasped by the distal end gripping portion 4a of the gripping forceps 4 protruding outward from the forceps channel opening of the distal end portion 2c of the endoscope 2. After that, by bending the bending portion 2e of the endoscope 2, the distal end portion 2c of the insertion portion 2a is raised as shown in FIG. 9, and the treatment target portion of the large intestine H1 is operated through the treatment side hole 6. The space portion 7 is pulled up. At this time, in the present embodiment, the shape of the treatment side hole 6 is changed to a vertically long rectangular opening 31 that is long in the axial direction of the sheath portion 5, so that the cross-sectional shape of the living tissue to be treated is also raised. It can be formed into a vertically long rectangular shape close to the shape of the opening 31. For this reason, as shown in FIG. 12B, the shape of the excision hole H3 formed when the entire layer of the large intestine H1 is excised has a length M4 in the direction orthogonal to the axial direction compared to the length M3 in the axial direction of the large intestine H1. Can be shortened. Accordingly, as shown in FIG. 12C, the entire excision hole H3 of the large intestine H1 can be ligated with one ligation tool 16, so that it is used when ligating the root portion of the biological tissue to be treated that has been pulled up. The number of ligatures 16 to be performed can be reduced as compared with the first embodiment.

  Therefore, the above configuration has the following effects. That is, in the treatment insertion assisting tool 3 of the present embodiment, the shape of the treatment side hole 6 is changed to a vertically long rectangular opening 31 that is long in the axial direction of the sheath portion 5. For this reason, at the time of full-thickness resection of the large intestine, the living tissue to be treated is pulled up into the working space 7 through the opening 31 of the treatment side hole 6, and the root portion of the living tissue to be treated is pulled up to the ligation tool 16. When ligating with, a smaller number of puncture needles 18 than in the first embodiment can be sutured. Thereby, the number of the puncture needles 18 to be used can be reduced, and the outer diameter of the entire sheath portion 5 can be reduced.

  FIGS. 13A to 13C show a third embodiment of the present invention. In the present embodiment, the configuration of the treatment insertion assisting tool 3 in the medical instrument system 1 for full colorectal resection of the second embodiment (see FIGS. 12A to 12C) is changed as follows. It is.

  That is, in this embodiment, as shown in FIG. 13 (A), inward both sides of the vertically long rectangular opening 31 of the treatment side hole 6 formed at the distal end portion of the sheath portion 5, respectively. A protruding portion 41 is formed. As a result, a narrow width portion 42 is formed at the midway portion in the axial direction of the opening portion 31 of the treatment side hole 6.

  When the treatment insertion aid 3 according to the present embodiment is used, when the treatment target portion of the large intestine H1 is lifted to the working space 7 through the treatment side hole 6 at the time of removing all the large intestine, it is lifted. The cross-sectional shape of the treatment target living tissue can also be formed in a shape close to the shape of the opening 31. At this time, as shown in FIG. 13B, the opening 31 is formed in the treatment target living tissue H4 that has been operated to lift the treatment target living tissue through the opening 31 of the treatment side hole 6 into the working space 7. A narrow constricted portion H5 is formed by the narrow portion. Therefore, in this state, when the two puncture needles 18 are pulled up to the biological tissue H4 to be treated next, a bent portion is formed when the ligation portion of the biological tissue H4 is folded at the constricted portion H5. be able to. Thereby, when the root part of the biological tissue to be treated is ligated with the ligation tool 16, the root part of the biological tissue to be treated can be reliably folded as shown in FIG. The part ligated by the ligation tool 16 can be reliably ligated without opening.

  Therefore, the above configuration has the following effects. That is, in the present embodiment, protrusions 41 that protrude inward are formed on both sides of the vertically long rectangular opening 31 of the treatment side hole 6, and the protrusions 41 are formed in the opening 31 of the treatment side hole 6. A narrow portion 42 is formed in the middle in the axial direction. Therefore, when the root portion of the biological tissue to be treated is ligated with the ligation tool 16, the root portion of the biological tissue to be treated can be reliably folded as shown in FIG. The part ligated with the tool 16 can be ligated reliably without opening.

  FIG. 14A shows a first modification of the opening 31 of the treatment side hole 6 of the treatment insertion aid 3 according to the third embodiment (see FIGS. 13A to 13C). Is shown. This modification is a horizontally long rectangular opening in which the sheath portion 5 has a short axial direction, like the treatment insertion aid 3 of the first embodiment (see FIGS. 1 to 11A and 11B). Protruding portions 52 that protrude inward are formed on both sides of the portion 51. These two protruding portions 52 are arranged at positions shifted in the axial direction of the sheath portion 5. Even in this case, when the base part of the biological tissue to be treated that has been pulled up is ligated with the ligature tool 16 in the same manner as in the third embodiment, the base part of the biological tissue to be treated can be reliably folded and ligated. The part ligated with the tool 16 can be ligated reliably without opening.

  FIG. 14B shows a second modification of the opening 31 of the treatment side hole 6 of the treatment insertion aid 3 of the third embodiment (see FIGS. 13A to 13C). Is shown. In this modified example, the shape of the treatment side hole 6 of the sheath portion 5 is replaced with an elliptical shape or a long rectangular opening portion 31 in which the axial direction of the sheath portion 5 is long as in the third embodiment. A circular opening 61 is formed. Protruding portions 62 that protrude inward are formed on both sides of the opening 61. As a result, a narrow width portion 63 is formed in the opening portion 61 of the treatment side hole 6 at a midway portion in the axial direction. Even in this case, when the base part of the biological tissue to be treated that has been pulled up is ligated with the ligature tool 16 in the same manner as in the third embodiment, the base part of the biological tissue to be treated can be reliably folded and ligated. The part ligated with the tool 16 can be ligated reliably without opening.

  FIGS. 15A and 15B show a fourth embodiment of the present invention. In the present embodiment, the configuration of the treatment insertion assisting tool 3 in the medical instrument system 1 for full colorectal resection of the second embodiment (see FIGS. 12A to 12C) is changed as follows. It is.

  That is, in this embodiment, as shown in FIG. 15A, the shape of the treatment side hole 6 formed in the distal end portion of the sheath portion 5 is changed to an opening portion 71 having a regular triangle shape. The equilateral triangular opening 71 is arranged on the distal end side of the sheath portion 5 with one side of the triangle oriented in a direction perpendicular to the axial direction of the sheath portion 5.

  In this embodiment, when the living tissue H6 to be treated is pulled up to the working space 7 through the regular triangular opening 71, the sectional shape of the living tissue H6 to be treated is also opened. It can be formed into a regular triangle shape close to the shape of 71. Therefore, the two puncture needles 18 can be punctured while passing through positions near the corners of the treatment target living tissue H6 having an equilateral triangle shape. As a result, when the root portion of the biological tissue to be treated that has been pulled up is ligated with the ligation tool 16, the root portion of the biological tissue H6 that is a regular triangular treatment subject is reliably folded as shown in FIG. Therefore, it is possible to reliably ligate without opening the portion ligated with the ligation tool 16.

  16 and 17 show a fifth embodiment of the present invention. In the present embodiment, the configuration of the treatment insertion assisting tool 3 in the medical instrument system 1 for removing the entire layer of the large intestine is changed as follows. The rest of the structure is the same as that of the medical device system 1 for full colorectal resection of the first embodiment, and the medical device system 1 for full thickness resection of the large colorectum of the first embodiment. The same parts are denoted by the same reference numerals, and the description thereof is omitted here.

  That is, in this embodiment, as shown in FIG. 16, a flat meat drop portion 81 is provided at the distal end portion of the sheath portion 5. The meat drop portion 81 is disposed in the vicinity of the treatment side hole 6 at the distal end portion of the sheath portion 5. Then, as shown in FIG. 17, this planar shape is formed by notching the wall portion of the lower portion of the plane connecting the left and right ligation channels 9 arranged inside both side portions of the treatment side hole 6. A meat drop portion 81 is formed.

  Therefore, the above configuration has the following effects. That is, in the present embodiment, the outer diameter dimension of the entire sheath portion 5 of the treatment insertion assisting tool 3 can be reduced by the planar meat drop portion 81 at the distal end portion of the sheath portion 5 of the treatment insertion assisting tool 3. it can. Thereby, the insertion property of the treatment insertion aid 3 can be improved.

  18 to 26 show a sixth embodiment of the present invention. In the present embodiment, the configuration of the treatment insertion assisting tool 3 in the medical instrument system 1 for full-thickness resection of the large intestine according to the first embodiment (see FIGS. 1 to 11A and 11B) is as follows. It has been changed.

  That is, in this embodiment, as shown in FIG. 18, an endoscope guide portion (tip constituent portion) 91 is provided on the distal end side of the treatment portion hole 6 of the sheath portion 5. As shown in FIG. 19, the endoscope guide portion 91 is formed to have substantially the same diameter as the main body portion (rear portion) 92 of the sheath portion 5 behind the treatment side hole 6 of the sheath portion 5. Further, an arm-shaped frame member 93 is disposed between the endoscope guide portion 91 and the main body portion 92 of the sheath portion 5 on the rear side of the treatment side hole 6. A treatment side hole 6 is formed below the frame member 93, and a work space portion 94 for the entire large intestine resection treatment is formed above the frame member 93.

  In the present embodiment, for example, a portion of the endoscope guide portion 91 in front of the treatment side hole 6 and a main body portion 92 of the sheath portion 5 behind the treatment side hole 6 are soft members. For example, it is formed of a resin material. The frame member 93 between the endoscope guide portion 91 and the main body portion 92 of the sheath portion 5 is formed of a hard member that is harder than the front and rear soft members, for example, a metal plate.

  Further, as shown in FIG. 20, an endoscope insertion lumen (endoscope insertion portion) 95 for inserting a guide endoscope 29 inserted in the body in advance is formed in the endoscope guide portion 91. ing. The endoscope insertion lumen 95 is disposed at a position corresponding to the endoscope insertion channel 8 of the main body portion 92 of the sheath portion 5.

  Further, a treatment instrument insertion lumen 96 is formed below the endoscope insertion lumen 95 at a position corresponding to the resection channel 10 and the four ligation channels 9. The front surface of the treatment instrument insertion lumen 96 is closed. The blocking surface forms a puncture needle protrusion prevention portion 97 that prevents the puncture needle 18 protruding forward from the ligation channel 9 from protruding outward.

  Further, a transparent plate-like pressing member 98 that suppresses the lifting of the distal end portion of the resecting snare 12 is provided on the upper surface of the treatment instrument insertion lumen 96. The pressing member 98 is disposed at a position corresponding to the excision channel 10. Then, as shown in FIG. 21, when the excision snare 12 is projected forward from the treatment side hole 6 from the excision channel 10, the excision snare 12 is inserted below the pressing member 98, and the excision snare 12 is removed. The lift of the tip of the snare 12 is suppressed.

  Further, a stopper 99 for positioning the tip position of the cutting snare 12 protrudes from the lower surface of the pressing member 98. Then, when the excision snare 12 is projected forward from the treatment side hole 6 from the excision channel 10 as shown in FIG. The protruding position of the tip of the snare 12 for use is regulated. As a result, when the operation wire 14 is further pushed out to the distal end side while the distal end portion of the excision snare 12 is in contact with the stopper 99, the excision loop portion 15 of the excision snare 12 is reliably expanded. It has become so.

  In addition, as shown in FIG. 23, a recessed locking groove 100 may be formed on the lower surface of the pressing member 98, and this locking groove 100 may function as a stopper at the tip of the cutting snare 12.

  Next, the operation of the above configuration will be described. When using the medical instrument system 1 of the present embodiment, first, the treatment insertion aid 3 is extrapolated to the direct-viewing type colonoscope 29 shown in FIG. At this time, as shown in FIG. 20, the insertion portion of the large intestine endoscope 29 passes from the endoscope insertion channel 8 of the sheath portion 5 of the treatment insertion assisting tool 3 through the work space portion 94 and passes through the endoscope guide portion. 91 is inserted into the endoscope insertion lumen 95 and protrudes forward of the endoscope guide portion 91.

  Thereafter, the large intestine endoscope 29 is first inserted to the treatment target site of the large intestine H1. Subsequently, the treatment insertion aid 3 is inserted to the treatment target site along the large intestine endoscope 29. Thereafter, the large intestine endoscope 29 is removed from the treatment insertion aid 3. As a result, only the treatment insertion aid 3 is left in the large intestine H1 in the inserted state.

  After removal of the large intestine endoscope 29, the endoscope 2 is inserted into the treatment insertion aid 3. At this time, the distal end portion 2d of the insertion portion 2a of the endoscope 2 is inserted from the inside of the endoscope insertion channel 8 of the sheath portion 5 of the treatment insertion aid 3 to the working space portion 94 as shown in FIG. . In this state, with the endoscope 2 inserted into the treatment insertion aid 3, the treatment side hole 6 of the treatment insertion aid 3 is aligned with the treatment target site under the field of view of the endoscope 2. At this time, the insertion position of the sheath portion 5 of the treatment insertion assisting tool 3 is adjusted so that the center of the treatment target site coincides with the center of the treatment side hole 6. In this state, the stopper 23a and the handle 23b of the excision operation part 23 are moved to the forward pushing position. At this time, as shown in FIG. 21, the excision snare introduction tube 13 is pushed out to the tip of the treatment side hole 6, and then the excision snare introduction tube 13 is pulled back to the proximal side, thereby performing the excision snare introduction tube. 13 and the snare 12 for excision are set at the set position for the excision operation as shown in FIG.

  Further, when the excision snare 12 protrudes forward from the treatment side hole 6 from the excision channel 10, the excision snare 12 is inserted below the pressing member 98, and the distal end of the excision snare 12 is Lifting is suppressed. Further, when the distal end portion of the excision snare 12 contacts the stopper 99, the protruding position of the distal end portion of the excision snare 12 is regulated. Here, when the distal end portion of the excision snare 12 is in contact with the stopper 99 and the operation wire 14 is further pushed out to the distal end side, the excision loop portion 15 of the excision snare 12 is surely expanded. The Thereby, the loop part 15 of the snare 12 for excision can be easily set in a state surrounding the treatment side hole 6.

  Thereafter, the grasping forceps 4 is inserted into the forceps channel insertion opening 2 h of the endoscope 2. The tip gripping portion 4a of the gripping forceps 4 inserted through the forceps channel of the endoscope 2 is projected outward from the forceps channel opening of the tip portion 2c of the endoscope 2 as shown in FIG. In this state, the tip gripping portion 4 a of the gripping forceps 4 is moved toward the treatment side hole 6.

  Subsequently, the treatment target site of the large intestine H1 is gripped by the tip gripping portion 4a of the gripping forceps 4. In this state, the bending portion 2e of the endoscope 2 is bent, so that the distal end portion 2c of the insertion portion 2a is raised as shown in FIG. The working space 7 is pulled up through.

  Thereafter, the puncture needle 18 is pushed out by pushing the puncture needle push-out stopper 27 against the needle slider 26 of the ligation operation unit 24. At this time, as shown in FIG. 25, the puncture needle 18 is punctured at the base of the tissue to be treated of the large intestine H1 that has been pulled up. In this state, the pusher wire 21 is then pushed in by the pusher wire stopper 28 of the ligation operation unit 24. At this time, the protruding member 20 is pushed out via the pusher wire 21, and the T bars 16 a and 16 b of the ligature 16 are pushed out by the protruding member 20. By the pushing operation of the projecting member 20, the T bars 16a and 16b penetrate the root portion of the tissue to be treated of the pulled large intestine H1, and penetrate to the front of the tissue to be treated of the pulled large intestine H1 (all layers of the large intestine H1). Pushed into position.

  In this state, the puncture needle push-out stopper 27 is pulled out with respect to the needle slider 26, and the puncture needle 18 is pulled out to the hand side. By this operation, the puncture needle 18 is pulled out from the treatment target tissue of the large intestine H1. At this time, since the T bars 16a and 16b of the ligation tool 16 are left at a position that penetrates to the front of the tissue to be treated of the pulled large intestine H1, the root portions of the tissue to be treated of the pulled large intestine H1 are T bars 16a and 16b. And ligated in a form sandwiched between T-bar sheaths 16c (see FIG. 10).

  Thereafter, by pulling out the handle 23 b of the excision operation portion 23, the loop portion 15 of the excision snare 12 is drawn into the excision snare introduction tube 13. At this time, as shown in FIG. 26, the upper part of the ligation part of the tissue to be treated of the large intestine H1 ligated by the ligation tool 16 is excised by the loop part 15 of the excision snare 12. As a result, the entire layer of the large intestine H1 is excised.

  Therefore, the above configuration has the following effects. That is, in the present embodiment, an endoscope guide portion 91 is provided on the distal end side of the sheath portion 5 of the treatment insertion assisting tool 3 with respect to the treatment side hole 6, and the distal end portion side of the treatment side hole 6 is provided. The guide endoscope 29 is inserted through the endoscope insertion lumen 95. Therefore, when inserting the treatment insertion assisting tool 3 into the large intestine H1, it is possible to prevent the distal end portion of the treatment insertion assisting tool 3 from separating from the endoscope 29, so that the treatment insertion assisting tool 3 is inserted into the large intestine H1. Insertability of the treatment insertion aid 3 can be improved.

  In the present embodiment, the endoscope guide portion 91 on the distal end side of the treatment side hole 6 of the sheath portion 5 of the treatment insertion assisting tool 3 and the sheath portion 5 on the rear side of the treatment side hole 6 are provided. The main body 92 is formed of a soft material. Thereby, since the part which is easy to elastically deform is provided before and after the hard frame member 93 of the sheath part 5 of the treatment insertion assisting tool 3, the hard part of the sheath part 5 of the treatment insertion assisting tool 3 is attached to the frame member. Only the length portion 93 can be shortened. As a result, when the sheath portion 5 of the treatment insertion aid 3 is inserted into the large intestine, the distal end constituent portion of the treatment side hole 6 and the rear portion of the treatment side hole 6 can be elastically deformed into an arbitrary shape. Thus, the insertion property into the large intestine can be enhanced.

  In the present embodiment, a transparent plate-like pressing member 98 that suppresses the lifting of the distal end portion of the resecting snare 12 is provided on the upper surface of the treatment instrument insertion lumen 96. Therefore, when the excision snare 12 is protruded forward from the excision channel 10, the excision snare is provided by the pressing member 98 at a position corresponding to the excision channel 10 at the end on the distal end side of the treatment side hole 6. The lifting of the tip of 12 can be suppressed. Thereby, the setting of the snare 12 for excision can be performed easily.

  In the present embodiment, a stopper 99 for projecting the position of the distal end of the cutting snare 12 is provided on the lower surface of the pressing member 98. Thus, when the excision snare 12 protrudes forward from the excision channel 10, the distal end portion of the excision snare 12 is brought into contact with the stopper 99 of the pressing member 98 to position the distal end position of the excision snare 12. be able to. Further, when the operation wire 14 is further pushed out to the distal end side while the distal end portion of the excision snare 12 is in contact with the stopper 99, the excision loop portion 15 of the excision snare 12 is surely expanded in a loop shape. Can be opened. Therefore, the setting of the excision snare 12 can be performed more easily.

  27 and 28 show a seventh embodiment of the present invention. In the present embodiment, the configuration of the treatment insertion assisting tool 3 in the medical instrument system 1 for resecting the large intestine of the large intestine according to the sixth embodiment (see FIGS. 18 to 26) is changed as follows.

  That is, in the present embodiment, external channel-shaped frame support members 101 are provided on both sides of the body portion 92 of the sheath portion 5 behind the treatment side hole 6 of the treatment insertion assisting tool 3, and these frame supports are provided. A length adjusting portion 102 capable of adjusting the length of the opening width in the axial direction of the treatment side hole 6 is provided by supporting the frame member 93 to be stretchable on the member 101. Thereby, the sheath part 5 of the treatment insertion assisting tool 3 is supported so that the front endoscope guide part 91 can be expanded and contracted with respect to the main body part 92 of the sheath part 5 behind the treatment side hole 6. .

  Then, in the treatment insertion assisting tool 3 of the present embodiment, as shown in FIG. 27, the front endoscope guide portion 91 is made to approach the main body portion 92 of the sheath portion 5 behind the treatment side hole 6. The treatment insertion assisting tool 3 can be extrapolated to the colonoscope 29 in a state where the length of the opening width in the axial direction of the treatment side hole 6 is shortened. Further, as shown in FIG. 28, the front endoscope guide portion 91 is projected forward from the main body portion 92 of the sheath portion 5 behind the treatment side hole 6, so that the axial direction of the treatment side hole 6 is increased. The length of the opening width can be increased. In this state, the entire large intestine can be excised.

  Therefore, the above configuration has the following effects. That is, in the treatment insertion assisting tool 3 of the present embodiment, the frame support members 101 in the form of external channels are provided on both sides of the main body portion 92 of the sheath part 5 behind the treatment side hole 6 of the treatment insertion assisting tool 3. And a length adjusting portion 102 that can adjust the length of the opening width in the axial direction of the treatment side hole 6 is provided by supporting the frame member 93 so that the frame supporting member 101 can extend and contract. Therefore, the entire length of the sheath portion 5 of the treatment insertion aid 3 is pushed by pushing the front endoscope guide portion 91 into a state in which the endoscope guide portion 91 is brought closer to the body portion 92 of the sheath portion 5 behind the treatment side hole 6. The length can be shortened to improve the insertion into the body.

  Further, the front endoscope guide portion 91 is projected forward from the main body portion 92 of the sheath portion 5 behind the treatment side hole 6, so that the length of the appropriate opening width in the axial direction of the treatment side hole 6 is increased. Can be secured. As a result, the insertion into the body is improved, and at the same time, there is an effect that the entire large intestine excision work can be reliably performed.

  29 (A), (B) through FIG. 32 show an eighth embodiment of the present invention. In the present embodiment, the configuration of the treatment insertion assisting tool 3 in the medical instrument system 1 for resecting the large intestine of the large intestine according to the sixth embodiment (see FIGS. 18 to 26) is changed as follows.

  In the present embodiment, as shown in FIG. 29A, the suction cap 110 is provided on the grip portion 5a of the treatment insertion aid 3. As shown in FIG. 29B, a suction conduit 111 extends along the axial direction inside the sheath portion 5 of the treatment insertion aid 3. A base end portion of the suction pipe 111 communicates with the suction cap 110. The distal end portion of the suction duct 111 extends to the distal end side of the sheath portion 5.

  A suction chamber 112 is formed inside the treatment insertion aid 3 so as to surround the treatment side hole 6. The suction chamber 112 communicates with the tip of the suction pipe 111. Further, a plurality of suction ports 113 are arranged around the treatment side hole 6 of the treatment insertion aid 3. Each of these suction ports 113 communicates with the suction chamber 112. As a result, the suction line 111 is configured to communicate from the suction chamber 112 to the outside of the treatment insertion aid 3 via the plurality of suction ports 113.

  Next, the operation of the present embodiment having the above configuration will be described. 30 to 32 show a procedure for performing suture excision of the entire layer of the large intestine with the treatment insertion assisting tool 3 of the present embodiment. In the present embodiment, most of the procedure for performing suture excision of the entire layer of the large intestine is the same as that in the sixth embodiment. Then, as shown in FIG. 30, the treatment target region of the large intestine H1 grasped by the distal grasping portion 4a of the grasping forceps 4 is the loop portion of the treatment side hole 6 and the excision snare 12 in the same procedure as in the sixth embodiment. 15 and is pulled up by the bending operation of the endoscope 2. At this time, suction is applied from the suction cap 110 in the present embodiment. Thereby, the peripheral part of the raising part of the large intestine H1 is adsorbed and fixed to the suction port 113.

  As shown in FIG. 31, after adsorbing and fixing the peripheral portion of the lifting portion of the large intestine H1 to the suction port 113, the base portion of the lifting portion of the large intestine H1 is pierced by the puncture needle 18 and sutured by the ligation tool 16. Thereafter, as shown in FIG. 32, the upper portion of the suture site by the ligation tool 16 (the pulled-up portion of the large intestine H1) is excised with the snare 12 for excision.

  Therefore, the above configuration has the following effects. That is, in the present embodiment, the peripheral portion of the raising portion of the large intestine H1 is adsorbed and fixed to the suction port 113. Therefore, the operation of penetrating the base portion of the lifted portion of the large intestine H1 with the puncture needle 18 is facilitated, and the base portion of the lifted portion of the large intestine H1 is sutured by the ligation tool 16 and the upper portion of the suture site by the ligature tool 16 is excised. It can be done reliably.

  In addition, when the peripheral site | part of the raising part of large intestine H1 is not fixed, since large intestine H1 moves when penetrating large intestine H1 with puncture needle 18, puncture needle 18 can be penetrated to the stable position. difficult. In particular, when the puncture needle 18 is punctured at the very side of the treatment side hole 6 in order to enhance the suturability (ensuring airtightness / watertightness, suturing strength, etc.), the peripheral portion of the lifting portion of the large intestine H1 moves during puncture. If this happens, the puncture needle 18 will slide on the surface of the large intestine Hl. Therefore, puncturing and suturing with the puncture needle 18 may be incomplete, and suturing failure may occur. In the present embodiment, the above-mentioned problem can be prevented by adsorbing and fixing the peripheral portion of the raising portion of the large intestine H1 to the suction port 113.

  33 to 37 show a ninth embodiment of the present invention. In the present embodiment, the configuration of the treatment insertion assisting tool 3 in the medical instrument system 1 for removing the entire layer of the large intestine according to the sixth embodiment (see FIGS. 18 to 26) is changed as follows.

  In the present embodiment, as shown in FIG. 33, a substantially rod-shaped exclusion element 114 that is inserted into the work space 94 of the treatment insertion aid 3 is provided. As shown in FIG. 34, the presser element 114 is provided with a substantially bar-shaped presser part 115. A proximal end portion of the exclusion portion 115 has a raised arm 116 that is bent obliquely upward in the rearward direction with respect to the axial direction of the exclusion portion 115. The exclusion element 114 is rotatably connected to a shaft 117 provided on the proximal side of the working space 94 at a connection part between the exclusion part 115 and the raising arm 116.

  The raising arm 116 is rotatably connected to one end portion of the link rod 118 via a first movable shaft 119a. The other end of the link rod 118 is connected to the tip of the raising wire 120 via a second movable shaft 119b so as to be rotatable. The raising wire 120 is inserted into the raising wire channel 121 so as to be movable in the axial direction. The raising wire channel 121 extends from the distal end side of the sheath portion 5 of the treatment insertion aid 3 to the proximal end portion side.

  The grasping portion 5a of the treatment insertion assisting tool 3 is provided with an exclusion portion operation portion 122. The exclusion portion operation portion 122 is provided with a raising lever 123 and a long and narrow slit 124 for guiding the same. The slit 124 extends along the long axis direction of the treatment insertion aid 3.

  FIG. 36 shows the exclusion unit operation unit 122 of the treatment insertion aid 3. The raising lever 123 is provided with a moving shaft 123 a that is inserted into the slit 124. A proximal end portion of the raising wire 120 is connected to the moving shaft 123a.

  The proximal end portion of the rising wire channel 121 is fixed at a position corresponding to the slit 124 of the grip portion 5a. The slit 124 allows the lumen of the rising wire channel 121 to communicate with the outside of the grip portion 5a. A similar slit 121 a is provided at a position corresponding to the slit 124 of the grip portion 5 a at the proximal end portion of the rising wire channel 121. The slit 121a communicates the lumen of the raising wire channel 121 and the inside of the grip portion 5a. The moving shaft 123a is inserted through the slit 124 of the grip portion 5a and the slit 121a of the raising wire channel 121, respectively.

  The raising lever 123 is provided with a large-diameter raising lever head 123b at one end of the moving shaft 123a and a large-diameter guide 123c at the other end. The raising lever head portion 123b is arranged outside the slit 124 (outside the grip portion 5a), and the guide 123c is arranged outside the slit 121a of the raising wire channel 121 (inside the grip portion 5a). Since the raising lever heads 123b and the guides 123c at both ends of the moving shaft 123a are larger in diameter than the slits 124 and 121a, they are not inserted into the slits 124 and 121a.

  A spring member 125 is interposed between the guide 123c and the raising wire channel 121. The spring member 125 is in contact with the guide 123c and the raising wire channel 121, respectively. As a result, the guide 123c is pushed up from the raising wire channel 121 by the spring force of the spring member 125, and the lever head 123b is urged in a direction to contact the outer surface of the grip portion 5a.

  During the operation of the exclusion unit operation unit 122, the raising wire 120 is pushed and pulled by an operation in which the raising lever 123 is moved in the axial direction along the slit 124, and the exclusion element 114 is moved via the raising wire 120. Driven. That is, when the lever head portion 123b of the raising lever 123 is moved to the distal end side along the slit 124, the exclusion portion 115 is the working space 94 in the working space 94 as shown in FIG. It is held in a state of extending straight along the direction. Here, when the lever head 123 b is moved to the hand side along the slit 124, the raising arm 116 of the retraction element 114 is pulled to the hand side via the raising wire 120 and the link rod 118. Therefore, as shown in FIG. 35, the exclusion portion 115 rises to a position having an angle with the axial direction of the treatment insertion aid 3 in the work space 94. It should be noted that the extruding element 114 may be provided not only on one side of the working space 94 but also on both sides.

  Next, the operation of the present embodiment having the above configuration will be described. At the time of use of the treatment insertion assisting tool 3 of the present embodiment, the raising lever 123 is first held at a position moved to the distal end side of the slit 124. At this time, as shown in FIG. 34, the repellent element 114 is held in a state of extending straight along the axial direction in the work space 94 (in a state of falling down in the work space 94). In this state, an operation such as inserting the treatment insertion aid 3 into the large intestine H1 is performed. The procedure for inserting the treatment insertion aid 3 into the large intestine H1 is the same as in the sixth embodiment.

  Then, as shown in FIG. 37, the treatment target region of the large intestine H1 grasped by the distal grasping portion 4a of the grasping forceps 4 is the loop portion of the treatment side hole 6 and the excision snare 12 in the same procedure as in the sixth embodiment. 15 and is pulled up by the bending operation of the endoscope 2. At this time, in this embodiment, the raising lever 123 on the proximal side is moved to the proximal side of the slit 124 and the exclusion portion 115 of the exclusion element 114 is raised in the work space 94. Thereby, it is possible to prevent the surrounding organ, for example, the tissue of the large intestine H1 from entering between the work space 94 and the endoscope 2 to obstruct the visual field of the endoscope 2.

  An engaging projection 126 is provided at the proximal end of the slit 124, and the raising lever head 123b can be engaged with and disengaged from the engaging projection 126 when the raising lever 123 is moved to the proximal side of the slit 124. You may make it the structure made to latch. In this case, since the raising lever 123 can be held on the proximal side of the slit 124, the operator manually moves the raising lever 123 toward the proximal side of the slit 124 during the entire layer resection of the large intestine H1. There is no need to hold it. Therefore, the workability of the entire layer excision of the large intestine H1 can be improved.

  FIG. 38 shows a first modification of the treatment insertion aid 3 according to the ninth embodiment (see FIGS. 33 to 37). In this modification, an extensible sheet member 130 is disposed between the frame member 93 and the exclusion portion 115 on the side of the working space 94.

  In the present modification, the sheet member 130 can be expanded between the frame member 93 and the displacement portion 115 when the displacement portion 115 of the displacement element 114 is raised in the work space 94. By 130, it is possible to more effectively prevent the surrounding organ, for example, the tissue of the large intestine H1, from entering between the work space 94 and the endoscope 2. Therefore, the tissue excretion can be increased as compared with the case where only the rod-shaped exclusion portion 115 is provided.

  FIGS. 39 and 40 show a second modification of the treatment insertion aid 3 according to the ninth embodiment (see FIGS. 33 to 37). In this modification, a substantially rigid cover 131 is provided on the outer peripheral surface on the distal end side of the treatment insertion aid 3 so as to cover the work space 94. An arm member 132 extends along the axial direction at the proximal end of the cover 131. The proximal end of the arm member 132 is pivotally supported by a rotating shaft 133 fixed to the outer peripheral surface of the sheath portion 5.

  In the present modification, as shown in FIG. 40, the treatment target site of the large intestine H1 held by the tip holding part 4a of the holding forceps 4 passes through the treatment side hole 6 and the loop part 15 of the excision snare 12. The endoscope 2 is pulled up by the bending operation. At this time, the cover 131 is rotated around the rotation shaft 133 by being curved while the distal end portion 2d of the endoscope 2 is in contact therewith. As a result, when the treatment target region of the large intestine H1 is grasped and pulled up by the distal end grasping portion 4a of the grasping forceps 4, the tissue such as the large intestine H1 entering the working space 94 can be removed by the cover 131.

  FIGS. 41 and 42 show a third modification of the treatment insertion aid 3 of the ninth embodiment (see FIGS. 33 to 37). In this modification, instead of the rigid cover 131 of the second modification, a substantially elastic elastic sheet 134 that covers the working space 94 is provided on the outer peripheral surface on the distal end side of the treatment insertion assisting tool 3.

  In the present modification, as shown in FIG. 42, the treatment target portion of the large intestine H1 held by the distal end holding portion 4a of the holding forceps 4 passes through the treatment side hole 6 and the loop portion 15 of the excision snare 12. The endoscope 2 is pulled up by the bending operation. At this time, the elastic sheet 134 is elastically deformed by bending while the distal end portion 2d of the endoscope 2 is in contact therewith. Thereby, when the treatment target region of the large intestine H1 is grasped and pulled up by the distal end grasping portion 4a of the grasping forceps 4, the tissue such as the large intestine H1 entering the working space 94 can be removed by the elastic sheet 134. .

  As described above, in the treatment insertion assisting tool 3 and the first to third modifications thereof according to the ninth embodiment, the retraction element 114, the sheet member 130, the rigid cover 131, the elastic sheet 134, and the like. Thus, it is possible to reliably prevent peripheral organs such as the large intestine tissue from entering the working space 94 of the treatment insertion aid 3. Therefore, it is possible to prevent the visual field of the endoscope 2 in the work space 94 of the treatment insertion assisting tool 3 from being obstructed by the large intestine tissue or the like, and the movement of the endoscope 2 or the distal end gripping portion 4a can be prevented. It can be prevented from being inhibited by. As a result, when the treatment target portion of the large intestine H1 is grasped and pulled up by the distal gripping portion 4a of the grasping forceps 4, the working space 94 can be reliably secured, and workability is improved.

  FIGS. 43 and 44 show a tenth embodiment of the present invention. In the present embodiment, the configuration of the treatment insertion assisting tool 3 in the medical instrument system 1 for removing the entire layer of the large intestine according to the sixth embodiment (see FIGS. 18 to 26) is changed as follows.

  In the present embodiment, an ultrasonic transmitter 135 connected to an ultrasonic observation device (not shown) is provided at the proximal edge of the treatment side hole 6. Further, a balloon 136 made of an elastic material is provided so as to cover the ultrasonic transmitter 135.

  The sheath portion 5 of the treatment insertion aid 3 has a water injection port 137 that opens to the inner side of the balloon 136, and a water injection conduit 138 that communicates with the water injection port 137. A proximal end portion of the water injection conduit 138 extends along the axial direction of the sheath portion 5 and communicates with a water injection cap (not shown) at the grip portion 5a on the proximal side.

  Next, the operation of the present embodiment having the above configuration will be described. In the present embodiment, when the entire large intestine is sutured and excised, as shown in FIG. 44, the treatment target portion of the large intestine H1 held by the distal end holding portion 4a of the holding forceps 4 is performed in the same procedure as in the sixth embodiment. Is pulled up by the bending operation of the endoscope 2 through the treatment side hole 6 and the loop portion 15 of the excision snare 12. At this time, in the present embodiment, deaerated water is injected from a water injection cap (not shown) when the large intestine H1 is pulled up. Thus, the lumen of the balloon 136 is filled with deaerated water through the water injection conduit 138 and the water injection port 137, and the burr 136 is brought into contact with the large intestine H1.

  Subsequently, the state inside the abdominal cavity of the large intestine H <b> 1 pulled into the working space 94 is observed through the intraperitoneal cavity and the treatment side hole 6 by the ultrasonic transducer 135. As a result, the large-sized blood vessel, the ureter and important nerves, the large intestine other than the small intestine and the target site, the mesentery, the greater omentum, and the fatty tissue were buried in the large intestine tissue pulled into the working space 94. Check whether surrounding organs such as the pancreas are involved. After confirming that these peripheral organs are not involved, penetration with the puncture needle 18, suturing, and excision of the large intestine with the excision snare 12 are performed.

  Therefore, the above configuration has the following effects. That is, in the present embodiment, when the ultrasonic transducer 135 and the balloon 136 are provided in a part of the treatment side hole 6 of the treatment insertion assisting tool 3, the entire colon can be punctured, sutured, and excised. It is possible to confirm the presence or absence of surrounding blood vessels or organs in advance and perform the work.

  In the present embodiment, an example in which the ultrasonic transducer 135 and the balloon 136 are provided only on the proximal side of the treatment side hole 6 is shown. However, the present invention is not limited to this, and the entire circumference of the treatment side hole 6 or a part thereof. You may provide in arbitrary positions.

The present invention is not limited to the above embodiment. For example, the ligation tool 16 is not limited to one in which two T bars 16a and 16b and a T bar sheath 16c are connected, and may be a stapler, an indwelling clip, an indwelling snare, or the like. Furthermore, it goes without saying that various modifications can be made without departing from the scope of the present invention.
Next, other characteristic technical matters of the present application are appended as follows.
Record
(Additional Item 1) At least an endoscope insertion channel and an ligation channel into which a ligation treatment tool for inserting a ligation tool for ligation of biological tissue is inserted into an insertion portion to be inserted into a lumen in the body, A resection channel into which a resection treatment tool for resecting a ligation portion of a living tissue ligated with the ligation tool is formed and disposed at a distal end portion of the insertion portion, and an outer periphery of the distal end portion of the insertion portion An opening for inserting a living tissue to be ligated into one side portion of the surface, and a working space portion formed on the other side of the outer peripheral surface of the distal end portion for operating the living tissue to be ligated from the opening portion. A treatment insertion aid comprising:
The treatment instrument for ligation set in a state of being inserted into the ligation channel and arranged at a position surrounding the periphery of the opening;
An endoscope that is inserted to the working space through the endoscope insertion channel;
A grasping treatment tool provided with a grasping portion for grasping a living tissue at a distal end portion of an insertion portion inserted into the working space through the channel of the endoscope;
A tissue pulling means for pulling up the living tissue to be ligated through the opening by a bending operation of the endoscope in a state where the living tissue is gripped by the gripping portion of the grasping treatment tool;
Ligating means for ligating the living tissue to be ligated pulled up by the tissue lifting means with the ligation instrument;
An excision treatment tool that is inserted into the excision channel and excises the ligated portion of the living tissue ligated by the ligation means,
The shape of the opening of the treatment insertion aid is set such that the length in the direction orthogonal to the axial direction is longer than the length of the treatment insertion aid in the axial direction. Medical instrument.

  (Additional Item 2) The treatment insertion aid is set such that the shape of the opening is longer in the direction perpendicular to the axial direction than the length in the axial direction of the treatment insertion aid. The medical device according to Additional Item 1, wherein the medical device has a rectangular shape.

  (Additional Item 3) The treatment insertion assisting tool is set so that the shape of the opening is longer in the direction orthogonal to the axial direction than the axial length of the treatment insertion assisting tool. 2. The medical instrument according to additional item 1, wherein the medical instrument has an elliptical shape.

  (Additional Item 4) In the treatment insertion assisting tool, a narrow narrow portion is formed in the axial direction in the opening portion, and the ligation portion of the living tissue is formed by the narrow portion when the living tissue is ligated. 4. The medical instrument according to any one of additional items 1 to 3, wherein a bent portion when folded is formed.

  (Additional Item 5) The treatment insertion assisting tool has an endoscope insertion portion for inserting a guide endoscope inserted into the body in advance on the distal end side of the opening portion of the insertion portion. Item 1. The medical device according to Item 1, which is characterized.

  (Additional Item 6) The treatment insertion assisting tool is formed by forming a distal end constituent part ahead of the opening and a rear part behind the opening with a soft member, and the distal constituent part and the opening. 6. The medical instrument according to appendix 5, wherein a frame member harder than the soft member is formed between the rear part and the part.

  (Additional Item 7) The insertion assisting tool for treatment is capable of adjusting the length of the opening width in the axial direction of the opening portion by supporting the distal end component portion so that it can be expanded and contracted with respect to the rear portion with respect to the opening portion. Item 7. The medical device according to Item 6, further comprising a length adjusting unit.

  (Additional Item 8) The resection insertion aid is protruded forward from the resection channel at a position corresponding to the resection channel at an end portion of the insertion portion closer to the distal end than the opening. The medical instrument according to Additional Item 1, further comprising a pressing member that suppresses lifting of the distal end portion of the treatment instrument for medical use.

(Additional Item 9) The treatment tool for excision includes a snare wire in which an excision loop portion whose distal end side can be expanded in a loop shape is formed, and a ring shape in which a proximal end portion side of the snare wire is inserted in a press-fitted state Formed by a snare for excision with a throttle member,
9. The medical instrument according to appendix 8, wherein the pressing member has a stopper for positioning a tip position of the excision snare.

  (Additional Item 10) The insertion assisting tool for treatment is provided in a lower portion of a plane connecting the right and left ligation channels disposed on both sides of the opening at a portion near the opening of the insertion portion. Item 2. The medical device according to item 1, wherein the device has a planar meat drop portion in which a wall portion is cut out.

(Additional Item 11) A guide endoscope insertion step for inserting a first-view type endoscope for insertion guide into a lumen in the body;
A treatment in which the first endoscope is inserted into an endoscope insertion channel of a treatment insertion aid, and the treatment insertion aid is inserted into a body lumen using the first endoscope as a guide. Insertion aid insertion process,
With the treatment insertion aid inserted into a body lumen, after pulling out the first endoscope from the endoscope insertion channel, the side-view type second endoscope is A treatment endoscope insertion step of inserting into an endoscope insertion channel and extending to the working space; and
After inserting the second endoscope, a resection snare treatment tool setting step of setting a snare treatment tool for resection in the resection channel at a position surrounding the periphery of the opening for inserting the living tissue to be ligated,
A grasping treatment instrument insertion step of inserting the grasping treatment instrument through the channel of the endoscope to the working space after setting the excision snare treatment instrument;
A tissue pulling step of pulling up the living tissue to be ligated through the opening by a bending operation of the endoscope in a state where the living tissue is gripped by the gripping portion of the grasping treatment tool;
A ligation step of ligating the living tissue to be ligated pulled up in the step with the ligation instrument;
And a tissue excision step of excising a ligated portion of the biological tissue ligated in the ligation step with a snare treatment tool for excision.

(Additional Item 12) A ligation channel into which a ligation treatment tool for inserting at least an endoscope insertion channel and a ligation tool for ligating biological tissue is inserted into an insertion portion to be inserted into a lumen in the body, An excision channel into which an excision treatment tool for excising a ligation portion of a living tissue ligated with a ligation instrument is formed and disposed at the distal end portion of the insertion portion, and the outer peripheral surface of the distal end portion of the insertion portion An opening for inserting a living tissue to be ligated into one side, and a working space formed on the other side of the outer peripheral surface of the distal end portion for operating the living tissue to be ligated from the opening. An insertion aid for treatment,
The treatment instrument for ligation set in a state of being inserted into the ligation channel and arranged at a position surrounding the periphery of the opening;
An endoscope that is inserted to the working space through the endoscope insertion channel;
A grasping treatment tool provided with a grasping portion for grasping a living tissue at a distal end portion of an insertion portion inserted into the working space through the channel of the endoscope;
A tissue pulling means for pulling up a living tissue to be ligated through the opening by a bending operation of the endoscope in a state where the living tissue is gripped by the gripping portion of the grasping treatment tool;
Ligating means for ligating the biological tissue to be ligated pulled up by the tissue lifting means with the ligation treatment tool;
A treatment tool for excision that is inserted into the excision channel and excises the ligated portion of the living tissue ligated by the ligation means;
A suction port for sucking and fixing a living tissue arranged so as to surround the opening of the treatment insertion assisting tool, and a suction port that communicates with the suction port and at the hand side grip of the treatment insertion assisting tool A medical instrument characterized by having a suction line to be operated.

(Additional Item 13) A ligation channel into which a ligation treatment tool for inserting at least an endoscope insertion channel, a ligation tool for ligation of biological tissue is inserted into an insertion portion to be inserted into a lumen in the body, and An excision channel into which an excision treatment tool for excising a ligation portion of a living tissue ligated with a ligation instrument is formed and disposed at the distal end portion of the insertion portion, and the outer peripheral surface of the distal end portion of the insertion portion An opening for inserting a living tissue to be ligated into one side, and a working space formed on the other side of the outer peripheral surface of the distal end portion for operating the living tissue to be ligated from the opening. An insertion aid for treatment,
The treatment instrument for ligation set in a state of being inserted into the ligation channel and arranged at a position surrounding the periphery of the opening;
An endoscope that is inserted to the working space through the endoscope insertion channel;
A grasping treatment tool provided with a grasping portion for grasping a living tissue at a distal end portion of an insertion portion inserted into the working space through the channel of the endoscope;
A tissue pulling means for pulling up a living tissue to be ligated through the opening by a bending operation of the endoscope in a state where the living tissue is gripped by the gripping portion of the grasping treatment tool;
Ligating means for ligating the biological tissue to be ligated pulled up by the tissue lifting means with the ligation treatment tool;
A treatment tool for excision that is inserted into the excision channel and excises the ligated portion of the living tissue ligated by the ligation means;
A medical instrument characterized by comprising tissue exclusion means for preventing surrounding living tissue from entering the working space.

  (Additional Item 14) The tissue exclusion means according to Additional Item 13 includes a first parallel position along the long axis direction of the treatment insertion assisting tool in the working space, and the long axis direction of the treatment insertion assisting tool. A medical instrument characterized by being a substantially rod-shaped tissue retraction tool that can be adjusted with an operating member on the hand side between a second raised position having an angle.

  (Additional Item 15) The tissue excluding means in Additional Item 13 covers the working space, and its proximal end is rotatably fixed to the treatment insertion assisting tool, and is applied by bending the endoscope. A medical instrument that is a cover that rotates in accordance with the movement of an endoscope in contact therewith.

  (Additional Item 16) A medical instrument, wherein the tissue exclusion means in the Additional Item 13 is a cover made of an elastic sheet that covers the working space.

(Additional Item 17) A ligation channel into which a ligation treatment tool for inserting at least an endoscope insertion channel, a ligation tool for ligation of biological tissue is inserted into an insertion portion to be inserted into a lumen in the body, and An excision channel into which an excision treatment tool for excising a ligation portion of a living tissue ligated with a ligation instrument is formed and disposed at the distal end portion of the insertion portion, and the outer peripheral surface of the distal end portion of the insertion portion An opening for inserting a living tissue to be ligated into one side, and a working space formed on the other side of the outer peripheral surface of the distal end portion for operating the living tissue to be ligated from the opening. An insertion aid for treatment,
The treatment instrument for ligation set in a state of being inserted into the ligation channel and arranged at a position surrounding the periphery of the opening;
An endoscope that is inserted to the working space through the endoscope insertion channel;
A grasping treatment tool provided with a grasping portion for grasping a living tissue at a distal end portion of an insertion portion inserted into the working space through the channel of the endoscope;
A tissue pulling means for pulling up a living tissue to be ligated through the opening by a bending operation of the endoscope in a state where the living tissue is gripped by the gripping portion of the grasping treatment tool;
Ligating means for ligating the biological tissue to be ligated pulled up by the tissue lifting means with the ligation treatment tool;
A treatment tool for excision that is inserted into the excision channel and excises the ligated portion of the living tissue ligated by the ligation means;
An ultrasonic transducer connected to an ultrasonic observation device is disposed on at least a part of the periphery of the opening in the insertion aid for treatment, and the ultrasonic transducer and the biological tissue pulled up are disposed. A medical instrument comprising: a balloon that is acoustically connected; a water inlet that injects deaerated water into the balloon; and a water injection conduit that communicates the water inlet with a water inlet on the hand side.

  INDUSTRIAL APPLICABILITY The present invention is effective in a technical field that uses an insertion assisting tool for full colorectal resection treatment that performs a treatment such as full colorectal resection and a medical instrument system thereof.

The perspective view which shows the external appearance of the whole medical device for the large intestine full thickness resection system of the 1st Embodiment of this invention. (A) is a side view which shows the front-end | tip part of the treatment insertion auxiliary tool of 1st Embodiment, (B) is a top view. III-III sectional view taken on the line of FIG. The top view which shows the state which set the T-bar ligation tool to the puncture needle in the medical device of 1st Embodiment. The perspective view which shows the T-bar ligation tool in the medical device of 1st Embodiment. The perspective view which shows the ligation unit pusher of the puncture needle in the medical device of 1st Embodiment. Explanatory drawing for demonstrating the state which has inserted the medical device of 1st Embodiment in the large intestine. The longitudinal cross-sectional view of the principal part which shows the state immediately before starting the raising operation by arrange | positioning the treatment side hole of the treatment insertion assistance tool of 1st Embodiment facing a treatment target tissue. In the state where the biological tissue to be ligated is pulled up to the working space through the treatment side hole of the treatment insertion assisting tool of the first embodiment, the puncture needle is punctured into the biological tissue to be ligated The longitudinal cross-sectional view of the principal part shown. The longitudinal cross-sectional view of the principal part which shows the state which excised the ligation part with the treatment tool for excision of the medical device of 1st Embodiment. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 illustrates a suturing operation of a large intestine excised with a medical instrument according to a first embodiment. The figure which shows the state made. FIGS. 2A and 2B show a second embodiment of the present invention, in which FIG. 1A is a plan view showing a distal end portion of a treatment insertion aid, FIG. 2B is a view showing a resected portion of the large intestine, and FIG. The figure which shows the state which ligated the part with the T-bar ligation tool. FIGS. 3A and 3B show a third embodiment of the present invention, in which FIG. 3A is a plan view showing a treatment side hole in a distal end portion of a treatment insertion assisting tool, and FIG. The top view which shows the state which made the puncture needle puncture the biological tissue of the ligation object pulled up to (c), (C) is the top view which shows the state which ligated the excised part of the large intestine with a T-bar ligation tool. (A) is a top view which shows the 1st modification of the treatment side hole of the treatment insertion assistance tool of 3rd Embodiment, (B) is a top view which shows the 2nd modification of the treatment side hole. . 4A and 4B show a fourth embodiment of the present invention, in which FIG. 4A is a plan view showing a treatment side hole at the distal end of a treatment insertion aid, and FIG. The top view which shows the state made to ligate. The perspective view of the principal part which shows the insertion assistance tool for treatment of the 5th Embodiment of this invention. The front view which shows the insertion assistance tool for treatment of 5th Embodiment. The perspective view which shows the external appearance of the whole medical device for the large intestine full thickness resection system of the 6th Embodiment of this invention. The perspective view which shows the front-end | tip part of the insertion assistance tool for treatment of 6th Embodiment. The longitudinal cross-sectional view of the principal part which shows the state by which the direct-viewing type | mold colonoscope was inserted in the treatment insertion assistance tool of 6th Embodiment. The longitudinal cross-sectional view of the principal part which shows the state by which the side endoscope was inserted in the treatment insertion assistance tool of 6th Embodiment. The longitudinal cross-sectional view of the principal part which shows the state which set the snare for excision around the treatment side hole of the treatment insertion assistance tool of 6th Embodiment. The longitudinal cross-sectional view of the principal part which shows the modification of the snare stopper of the insertion assistance tool for treatment of 6th Embodiment. The longitudinal cross-sectional view of the principal part which shows the state which pulled up the biological tissue of ligation object to the working space part through the treatment side hole of the treatment insertion assistance tool of 6th Embodiment. The longitudinal cross-sectional view of the principal part which shows the state which made the puncture needle puncture the biological tissue of the ligation object pulled up to the working space part of the treatment insertion assistance tool of 6th Embodiment. The longitudinal cross-sectional view of the principal part which shows the state which cut the ligation part with the treatment tool for excision of the insertion assistance tool for treatment of 6th Embodiment. The perspective view which shows the front-end | tip part of the treatment insertion assistance tool of the 7th Embodiment of this invention. The perspective view which shows the state which moved the front-end | tip part of the treatment insertion assistance tool of 7th Embodiment ahead. (A) is a perspective view which shows the front-end | tip part of the treatment insertion assistance tool of the 8th Embodiment of this invention, (B) is a longitudinal cross-sectional view of the front-end | tip part of the treatment insertion assistance tool. The longitudinal cross-sectional view of the principal part which shows the state which pulled up the biological tissue of ligation object to the working space part through the treatment side hole of the treatment insertion assistance tool of 8th Embodiment. The longitudinal cross-sectional view of the principal part which shows the state which made the puncture needle puncture to the biological tissue of the ligation object pulled up to the working space part of the treatment insertion assistance tool of 8th Embodiment. The longitudinal cross-sectional view of the principal part which shows the state which cuts off a ligation part with the treatment tool for excision of the insertion assistance tool for treatment of 8th Embodiment. The side view of the insertion assistance tool for treatment of the 9th Embodiment of this invention. The longitudinal cross-sectional view of the front-end | tip part of the insertion assistance tool for treatment of 9th Embodiment. The longitudinal cross-sectional view which shows the state which the exclusion part of the insertion assistance tool for treatment of 9th Embodiment stood up in the position which had an angle with the axial direction of the insertion assistance tool for treatment in work space. The longitudinal cross-sectional view which shows the exclusion part operation part of the insertion assistance tool for treatment of 9th Embodiment. The side view of the principal part which shows the state which pulled up the biological tissue of ligation object to the working space part through the treatment side hole of the treatment insertion assistance tool of 9th Embodiment. The side view of the principal part which shows the 1st modification of the insertion assistance tool for treatment of 9th Embodiment. The side view of the principal part which shows the 2nd modification of the insertion assistance tool for treatment of 9th Embodiment. The side view of the principal part which shows the state which pulled up the biological tissue of the ligation object to the working space part through the treatment side hole of the treatment insertion assistance tool of the 2nd modification, and shows a part in cross section. The side view of the principal part which shows the 3rd modification of the insertion assistance tool for treatment of 9th Embodiment. The side view of the principal part which shows the state which pulled up the biological tissue of the ligation object to the working space part through the treatment side hole of the treatment insertion assistance tool of the 3rd modification in a cross section. The longitudinal cross-sectional view of the principal part which shows the front-end | tip part of the treatment insertion assistance tool of the 10th Embodiment of this invention. The longitudinal cross-sectional view of the principal part which shows the state which pulled up the biological tissue of a ligation object to the working space part through the treatment side hole of the treatment insertion assistance tool of 10th Embodiment.

Explanation of symbols

    DESCRIPTION OF SYMBOLS 5 ... Sheath part (insertion part in large intestine), 6 ... Side hole for treatment, 7 ... Working space part, 16 ... Ligation tool (ligation means), 11 ... Snare unit for excision (treatment tool for excision), H1 ... Large intestine .

Claims (12)

A treatment side hole for inserting a living tissue to be treated into one side of the outer peripheral surface of the distal end portion of the insertion portion in the large intestine to be inserted into the large intestine, and a work for full-thickness resection of the large intestine on the other side of the outer peripheral surface of the distal end portion Each space part is formed,
The biological tissue to be treated is pulled up into the working space through the treatment side hole, and the base portion of the biological tissue to be ligated is ligated by ligation means, and then the ligated biological tissue is ligated. In the insertion aid for treatment of full-thickness colorectal resection that excises the upper part of the part with a treatment tool for resection,
The shape of the treatment side hole of the large intestine insertion portion is set so that the length in the direction orthogonal to the axial direction is longer than the length in the axial direction of the large intestine insertion portion. Insertion aid for treatment of full-thickness colorectal resection.   The large intestine insertion portion has a rectangular shape in which the shape of the treatment side hole is set so that the length in the direction orthogonal to the axial direction is longer than the axial length of the large intestine insertion portion. The insertion assisting device for treatment of full-thickness resection of the large intestine according to claim 1.   The insertion part in the large intestine has an elliptical shape in which the shape of the treatment side hole is set so that the length in the direction orthogonal to the axial direction is longer than the length in the axial direction of the treatment insertion aid. The insertion assisting device for treatment of full thickness resection of the large intestine according to claim 1.   The insertion portion in the large intestine is formed when a narrow narrow portion is formed in the axial direction in the treatment side hole, and the ligation portion of the living tissue is folded by the narrow portion when the living tissue is ligated. 4. The insertion assisting device for treatment of full-thickness colorectal resection according to any one of claims 1 to 3, wherein a portion can be formed.   The insertion part in the large intestine is formed by a soft member having a distal tip constituent part ahead of the treatment side hole and a rear part of the treatment side hole, and the tip constituent part and the treatment side The insertion assisting tool for full-colorectal resection of large intestine according to claim 1, wherein a frame member that is harder than the soft member is formed between the rear part and the hole.   The insertion portion in the large intestine has a length that allows the distal end component portion to be extended and retracted with respect to a rear portion of the treatment side hole and adjusts the length of the axial opening width of the treatment side hole. 6. The insertion assisting device for treatment of full-thickness resection of the large intestine according to claim 5, further comprising an adjusting portion. A treatment side hole for inserting a living tissue to be treated into one side of the outer peripheral surface of the distal end portion of the insertion portion in the large intestine to be inserted into the large intestine, and a work for full-thickness resection of the large intestine on the other side of the outer peripheral surface of the distal end portion Each space part is formed,
The biological tissue to be treated is pulled up into the working space through the treatment side hole, and the base portion of the biological tissue to be ligated is ligated by ligation means, and then the ligated biological tissue is ligated. In the insertion aid for treatment of full-thickness colorectal resection that excises the upper part of the part with a treatment tool for resection,
The shape of the treatment side hole of the intra-colon insertion part is set such that the axial length of the intra-colon insertion part is longer than the length in the direction orthogonal to the axial direction. An insertion assisting device for treatment of total colorectal resection as a feature. There are at least an endoscope insertion channel, a ligation channel into which a ligation treatment tool for inserting a ligation tool for ligation of living tissue is inserted into an insertion portion in the large intestine, and a treatment tool for resection. A resection channel to be inserted, and a treatment side hole for inserting a living tissue to be treated into one side of the outer peripheral surface of the distal end of the insertion portion, and the entire large intestine on the other side of the outer peripheral surface of the distal end An insertion aid for treatment in which a working space portion for layer resection is formed, and
The ligation instrument inserted into the ligation channel;
An endoscope that is inserted to the working space through the endoscope insertion channel;
A grasping treatment tool provided with a grasping portion for grasping a living tissue at a distal end portion of an insertion portion inserted into the working space through the channel of the endoscope;
A resection treatment tool inserted into the resection channel,
In a state where the biological tissue to be treated is grasped by the grasping portion of the treatment instrument for grasping, the biological tissue to be treated is pulled up through the treatment side hole by the bending operation of the endoscope, and then pulled up. A medical instrument system for ligating a base portion of a living tissue to be treated with the ligation treatment tool and further excising an upper portion of the ligated portion of the ligated biological tissue with the resection treatment tool,
The treatment insertion aid is set such that the shape of the treatment side hole is longer in the direction perpendicular to the axial direction than the length of the treatment insertion aid in the axial direction. A medical device system characterized by that.   9. The treatment insertion assisting tool has an endoscope insertion portion for inserting a guide endoscope that is inserted into the body in advance on the distal end side of the treatment side hole. The medical device system described.   The treatment insertion assisting tool has a distal end portion of the excision treatment tool that protrudes forward from the excision channel at a position corresponding to the excision channel at an end portion on the distal end side of the treatment side hole. The medical device system according to claim 8, further comprising a pressing member that suppresses lifting of the medical device. The treatment tool for excision includes a snare wire in which a loop portion for excision whose front end side can expand in a loop shape is formed, and a ring-shaped throttle member into which a proximal end side of the snare wire is inserted in a press-fitted state. Formed by an excision snare
The medical instrument system according to claim 10, wherein the pressing member includes a stopper for positioning a distal end position of the excision snare.   The treatment insertion assisting tool is a wall of a lower portion of a plane connecting the right and left ligation channels disposed inside both side portions of the treatment side hole in a vicinity of the treatment side hole of the insertion portion. The medical instrument system according to claim 8, further comprising a planar meat drop portion having a portion cut out.

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